Research finds ACA reduces racial and ethnic disparities in healthcare

A new University of Michigan research study shows how the Affordable Care Act has reduced racial and ethnic disparities in health insurance coverage.

The ACA — signed into law by President Obama on March 23, 2010 — aims to lower the percentage of uninsured Americans and make healthcare more affordable and of higher quality. The ACA is projected to undergo numerous provisions until 2020. Currently, it is estimated that 29 million Americans (9.2 percent of the population) are without health insurance.

The research team, comprised of scholars from the University and the University of Wisconsin at Madison, analyzed data from the American Community Survey from 2008 to 2014 to examine the change in percentage of nonelderly adults who were uninsured, covered by Medicaid or covered by a private health insurance.

In January 2014, the ACA adopted its main provisions, which included establishing minimum standards for the health insurance policies, which require individuals who are uninsured to buy insurance or to pay a penalty unless the individual has a financial hardship or is part of a recognized religious sect that has contrary views of healthcare. These provisions additionally prohibit companies from denying individuals healthcare based on pre-existing conditions and provide federal subsidies for low-income individuals and families.

Helen Levy, research associate professor at the Ford School of Public Policy and one of the co-authors on the study, said the provisions in 2014 helped reduce the healthcare coverage disparities in Blacks and Hispanics due to ACA subsidizing of private insurance as well as the increased availability of Medicaid coverage in many states for low-income individuals and families.

The team found that, in 2013, 40.5 percent of Hispanic and 25.8 percent of Black adults were uninsured; however, after the main ACA provisions went into effect in 2014, the percentage of uninsured adults was reduced by 7.1, with a 5.1 percent reduction for Hispanics and 5.1 percent for Blacks, which is much larger than the three percent reduction for whites.

These results show that the ACA has made progress in reducing the disparities in healthcare coverage, though substantial racial and ethnic disparities still exist, Levy said.

Levy said other factors, such as income and citizenship status, explain the disparity in healthcare coverage.

“Income is also a very important factor that explains the disparity in coverage between Blacks and whites,” Levy said. “For Hispanics, whether or not they are citizens is an important determinant of coverage.”

In 2014, the coverage gap between Blacks and whites was only 3.2 percent in the lowest income category, while in contrast the disparity was nine percent for all income categories combined. The coverage gap between Hispanic noncitizens and whites was more than 40 percent, as many Hispanic immigrants are ineligible for Medicaid on top of additional language barriers and a lack of available government subsidies under ACA.

Levy said, depending on citizenship status, there were coverage gaps within the Hispanic ethnic group as well, highlighting how there is still a lot of work to be done to increase the accessibility of health insurance.

“In particular, Hispanic noncitizens are much less likely to have coverage than Hispanic citizens,” Levy said. “This was true before ACA and remains true now. So there is still a lot of work to do, in terms of making health insurance coverage available to all members of society.”

The team also found that the reduction was greater in states that expanded their Medicaid programs, leading the authors of the study to conclude that, to reduce the percentage of uninsured people further, more states will need to adopt ACA and expand Medicaid.

However, Levy said it is important to realize that the Medicaid expansion will not fully eliminate the coverage gap.

“Even if all states implemented the ACA’s optional Medicaid expansion, racial and ethnic gaps in coverage would be only a little bit smaller than they are now,” Levy said.

The team is currently examining healthcare coverage at the state level, specifically how the expansion of public coverage in Michigan by the Healthy Michigan Plan affects healthcare coverage for low-income Michiganders.